Provider First Line Business Practice Location Address:
4810 OHIO RIVER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-412-0358
Provider Business Practice Location Address Fax Number:
304-736-5438
Provider Enumeration Date:
09/22/2006